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Understanding the sleep stages and cycles can help you
plan when to go to sleep and when to awaken for maximum
beneft. For example, if you tend to go bed at 11:00 p.m., read
a book, and drift off to sleep about 11:30 p.m., your ideal
waking time might be after four sleep cycles, which would
bring you to 7:30 a.m. If you felt you needed more sleep, you
would go to bed at 10:00 p.m. to allow completion of fve
sleep cycles. Four cycles of undisturbed sleep may render
you fresher and feeling better in the morning than your
friends sleep of fve cycles in which her cat disturbed her
sleep on and off. Experiment to fnd out what works best
for you.
The Effect of Too Little Sleep on Your Health
For the majority of people who get inadequate sleep, the
human brain and body experience alarming symptoms. The
research is conclusive:
1. The National Sleep Foundation estimates that over 30%
of the population sleep less than six hours at night. What
is the big deal, you ask? Sleep is a critical cornerstone
of good health. Sleep is the opportunity for the body to
restore balance. When that doesnt happen, internal sys-
tems break down over time.
2. There is a direct relationship between the lack of sleep
and the obesity epidemic. Insuffcient sleep causes an
increase in the release of ghrelin, an appetite-enhancing
hormone secreted by the stomach that makes you want to
eat. At the same time, it causes a decrease in the secretion
of leptin, an appetite-suppressing hormone produced by
fat cells. This, in addition to the fatigue caused by insuf-
fcient sleep, leads to weight gain. Unfortunately, this is a
major problem in children as well, and is a contributing
factor to childhood obesity.
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13
3. Insuffcient sleep also causes insulin resistance, which can
contribute to a diagnosis of type 2 diabetes. The American
Diabetes Association is now publicizing the fact that ade-
quate sleep is an important part of treating diabetes.
4. Inadequate sleep also results in cognitive dysfunction
and sleepiness. If you have insuffcient sleep, you tend to
underperform at work. You have diffculty concentrating,
focusing, remembering, and you tend to become easily
irritated.
5. Breaking new research has found that lack of sleep and
poor quality sleep can compromise your immune system
and inhibit your immunological reaction to infection. In
one study, people deprived of sleep for a few days fol-
lowing an infuenza vaccine had a much lower immune
response as measured by antibody production when
tested two weeks after vaccination.
Abnormalities in your immune systems responses to
fghting infections or diseases sometimes create infam-
matory conditions such as allergies, asthma, heartburn, or
ulcers. Chronic infammation moves beyond the local organ
or tissue, where it starts as a healing agent, and moves
into the blood vessels and organs. When this happens, the
changing characteristics of infammation are now systemic
infammation.
In one sleep study, researchers tested and examined the
participants specifc levels of three infammatory markers.
These three markers are associated with a higher risk of ath-
erosclerosis, predisposing one to heart attacks and strokes:
1. Fibrinogen (blood-clotting protein)
2. Interleukin-6 (proinfammatory and anti-infammatory
cytokine)
3. C-reactive protein (CRP levels in blood rise in response to
infammation)
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Participants with poor quality sleep had higher levels in
all three infammatory markers while those who slept six
to ninehours had lower levels. The conclusion of the study
indicated:
1. Poor sleep quality and short sleep durations are associ-
ated with higher levels of infammation.
2. Normalizing sleep quality and duration reduces the risk
of infammation in cardiovascular disease.
3. There is a direct link between lack of sleep and hyper-
tension and cardiovascular disease. If you are chroni-
cally sleep deprived, your body produces excessive
amounts of the stress hormones adrenaline and nor-
adrenalin. The result is progressive blood pressure
elevations. Additionally, when you sleep, your average
blood pressure drops by 10 to 15 points. Sleeping less
deprives you of several hours of this important decrease
in blood pressure that you should be experiencing every
night. According to Professor Francesco Cappuccio
of the University of Warwick Medical School: If you
sleep less than six hours per night and have disturbed
sleep, you stand a 48% greater chance of developing or
dying from heart disease and a 15% greater chance of
developing or dying of a stroke.
4. Lack of sleep can exacerbate multiple sclerosis. A recent
study revealed that cells that produce myelin, the nerve-
insulating material that is destroyed in multiple sclerosis,
double in production during REM sleep and are destroyed
in sleep-deprived mice. (Because mice and humans share
the brains ancient circuitry, these fndings are important
to note.)
5. There is a potential connection to Alzheimers disease.
Another recent study of mice showed that during sleep
the process through which cerebrospinal fuid cleanses
The Cornerstone of Health

15
the brain of harmful wastes such as beta amyloid, the
protein affecting memory loss in Alzheimers disease,
increases tenfold. Lack of sleep compromises this process.
I cannot emphasize enough how an uninterrupted night
of solid eight-hour sleep can help maintain good health and
improve both emotional stability and mental functions.
Fatigue and Brain Fog
Sandy appeared more than just tired during our con-
sultation. The word exhausted came to mind, as I quickly
scanned the dark circles under her puffy eyes. Her shoul-
ders sagged as if she were holding the weight of the world.
I welcomed her and asked, How can I help you today?
Are you not sleeping? My bit of humor in asking if she
had come to a sleep clinic because she wasnt sleeping well
few right over her head.
Rather, Sandy focused mentally on her story, and with
scrunched brows, she began: I am not sure Ive slept well
now for the past yearabout the time my husband of 30
years needed emergency heart surgery. We got through
that, and he gained back the weight he lost before the heart
surgery. His snoring also returned because he now sleeps
on his back. Iseem to spend the night waking him up to ask
that he turn on his side, and then I cant sleep at all.
Sandy, were you sleeping better before his heart sur-
gery? Were your patterns of sleep different?
Hmm, well, thinking back, every time he gained a lot
of weight, he snored more. So I woke up several times a
night, and I tossed and turned a lot. I could tell when I was
tired because Id take a nap, pass out, and just be dead to the
world . . . maybe about once a week. Now and then he tried
to wake me up to make sure I wasnt dead.
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I laughed at her humor, but she did not. She was dead
serious. My mind started clicking through my mental fle
of symptoms, checking for types of insomnia, possible
patterns of sleep deprivation, and reviewing her sleep
hygiene. I asked, Sandy, did your husband come with
you today?
No.
Any particular reason why?
I didnt want him to come. I want to fnd a way for me
to sleep frst, and then I can help him with any sleep issues.
I read your sleep column in the paper on sleep apnea, and
Ithink he might have that. But . . .
I waited. She seemed to forget what she was saying.
Sandy, you were saying you wanted to see me frst. Why
is that?
Yeah. I did, and forgetting like that in the middle
of conversation is one reason. I am forgetful. My brain is
mush most of the day, although I seem to do okay at work.
Sometimes I run home on my lunch break and just take a
short nap. A power nap, I think it was called in a magazine.
Even 10 minutes helps.
Does a power nap really help?
Truthfully, no, in regard to sleep, in that I can rest for
10 minutes and stare at the wall, but I am not asleep. Then
I dont want to go back to my secretarial chair for fve more
hours.
I asked Sandy further questions about her sleep routines
and behaviors. In the process, she hinted at the fact that she
had shared a bed with her husband all the years of her mar-
riage. She asked if sleeping alone would help her.
I am not sure, Sandy. We wont know how you might
sleep until you give it a try, and I can help you with that.
You can create a quiet, dark sleeping space, and that will
be a good start. Is that one reason you came to the sleep
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17
clinic? She nodded, and Sandy and I concluded her sleep
history.
After her appointment, Sandy thanked me and said she
might try sleeping by herself for a while and see if she felt
any better. She made a return appointment for herself and
one for her husband also.
Sandy was true to her word and brought her husband to
the sleep clinic. Casually, she told me that she had moved to
a cooler, downstairs bedroom to sleep. Her fatigued appear-
ance had improved.
I saw most of the symptoms of sleep deprivation in Sandy:
sleepiness (nap at noon), fatigue, problems with attention
and memory, and cognitive impairment (brain fog) in that
she couldnt make a frm decision about changing sleeping
arrangements, Months passed before she could decide to get
help, and her mind ruminated on such issues in those hours
of lost sleep. I also documented that she woke up often dur-
ing the night to ask her husband to change sleeping posi-
tions. I suspect she did not reach the restorative sleep stages.
In summary, Sandys sleep disturbances and the result-
ing symptoms fed each other and created a vicious circle:
1. The environment: Her sleeping in the same bed, and even
the same room, with a bed partner whose sleep apnea
and weight contributed to her lack of sleep.
2. The lack of deep sleep: Sandy awakened consistently
throughout the night, keeping her from the deeper, restor-
ative stages of sleep.
The results of sleep disturbance? An increase in stress
hormones, high blood pressure, and all the signs of emo-
tional agitation, mental fatigue, and daytime sleepiness.
I feel its important to note that Sandy was only 48 years
old. You may have thought she was older based on her
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many years of marriage, her husbands sleep apnea and
heart disease, her fatigue, and her slowness at work. Many
of her symptoms are typically associated with aging. But
sleep disorders are happening at younger ages. You could
meet a Sandy who is 18 or 28 years old. Sleep rejuvenates,
and those who do not create the space and goal of coveting
it for themselves will sound just like Sandy.
Take the First Step and the Rest Falls into Place
What can you do to improve your sleep?
First, come to the realization that you need at least seven
to nine hours of sleep each night. Not accepting this one fact
could have profound costs for you, including your suffering
from diabetes, heart disease, stroke, or obesityall of which
link to a lack of sleep.
Second, practice good sleep hygiene as outlined in the
next chapter to get those hours. This may involve chang-
ing long-held habits and modifying your behavior, but
I hope the information in this chapter will motivate you.
Good sleep brings clear thinking and vitality. I encourage
you to value sleep and allow yourself to embrace a lifestyle
change to improve your entire outlook and health. Instead
of thinking of sleep as a necessary evil, think of it as a val-
ued commodity you invest in. Instead of thinking of sleep
as a recurring event that robs you of valuable time, think of
it as a luxurious opportunity to fnd peace. Sleep is trans-
formative. If you value your life and want to enjoy better
health, then deep sleep is your prized ally.